Active Listening

SJT Textbook: Active Listening

Active Listening MSRA

This guide breaks down the core skill of Active Listening MSRA scenarios. In the Professional Dilemmas paper, examiners are looking for “Active” engagement—listening to understand, not just listening to reply.

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🎯 THE CORE PRINCIPLE

Active listening is more than hearing words; it is a deliberate, structured communication skill that combines attention, empathy, reflection, and clarification to understand what matters most to the patient. It allows you to uncover ideas, concerns, and expectations (ICE), explore emotions, and tailor your assessment and plan safely.

In the SJT, high-scoring answers show you inviting the story with open questions, giving space for the patient to talk, and using body language that signals focus and respect (e.g. SOLER). You reflect and validate feelings, summarise key points in plain language, and agree a clear plan with safety-netting.

The exam penalises premature reassurance, rushing straight to tests or prescriptions, ignoring emotions, or failing to check that the patient has understood. The safest pattern is: Open → Explore → Reflect → Summarise → Plan → Teach-back → Document.

In Active Listening MSRA questions, body language is often the key differentiator. The SOLER model (Sit squarely, Open posture, Lean forward, Eye contact, Relax) is the standard you must demonstrate.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Start with an open question and use ICE to uncover the real agenda.
2. Use attentive body language (SOLER) and minimise distractions while the patient talks.
3. Reflect and validate emotions using short empathic statements.
4. Clarify and summarise the story in plain language, inviting corrections.
5. Use teach-back to check understanding of diagnosis, plan, and red flags.
6. Signpost the structure of the consultation so the patient knows what to expect.
7. Prioritise key problems together and agree a realistic next step.
8. Provide clear safety-netting: when and how to seek further help.
9. Document ICE, main findings, red flags discussed, agreed plan, and safety-net.
10. Arrange follow-up when concerns are complex or time is short.

To score highly in Active Listening MSRA ranking questions, you must use the “Teach-Back” method. This ensures the patient has actually understood your advice.

These traps share a theme of prioritising speed, convenience, or your own agenda over understanding, empathy, and shared decision-making.

💬 MODEL PHRASES (Use These in SJT Logic)

* “It sounds really upsetting; let me check I have understood what you have told me so far.”
* “What were you hoping we might do today to help with this?”
* “So far I have heard that…, have I missed anything important from your point of view?”
* “Just to be sure I explained this clearly, how will you take the new medicine and when would you seek help?”

Lead with an open question • Identify Ideas, Concerns, Expectations • Show empathy • Test understanding • Explain the plan • Note key points and safety-net

📋 QUICK FAQ

What if I am short on time?
Use a “minimum effective dose”: one open question, one named feeling, a brief summary, a single clear next step, and teach-back on the plan and red flags.

How do I manage a very talkative patient?
Acknowledge and then signpost: “So I can help you best, I will summarise what I have heard and then ask a few focused questions.”

Should I still reflect emotions if the concern seems minor?
Yes. Brief validation such as “I can see this has been frustrating” reduces complaints and improves adherence.

What should I record in the notes?
Record ICE, key symptoms and red flags, agreed plan, safety-net advice, and any follow-up arrangements.

Is it ever acceptable to be mostly task-focused?
Practical tasks still need a brief active listening cycle: open, reflect, summarise, plan, and record. Purely transactional consultations risk omissions and complaints.

📚 GMC ANCHOR POINTS

• Communicate clearly, listen to patients, and respond to their concerns and preferences (GMC Good Medical Practice).
• Work in partnership with patients, supporting shared decision-making (Decision making and consent).
• Treat patients with kindness, courtesy, and respect, especially when they are distressed.
• Make and keep clear, accurate, and timely clinical records.

💡 MINI PRACTICE SCENARIO

A patient with chronic back pain fears it might be cancer. They talk quickly, jumping between symptoms, previous tests, and stories from relatives.

Best action: Acknowledge their worry, ask an open question to understand what is worrying them most, reflect a key feeling, summarise the main points, then explain your assessment plan and safety-net, using teach-back to check understanding.
Why: This sequence follows active listening principles, addresses emotion and agenda, and leads to a shared, safe plan aligned with GMC expectations.

🎯 KEY TAKEAWAYS

✓ Open questions and ICE uncover the real agenda.
✓ Reflecting emotions reduces distress and builds trust.
✓ Summarising and teach-back check understanding and reduce error.
✓ Safety-netting and documentation are part of active listening, not optional extras.
✓ Under time pressure, a short but structured active listening approach still scores highly.

🔗 RELATED TOPICS

* → Dealing with Angry or Distressed Patients
* → De-escalation Techniques
* → Breaking Bad News
* → Working with Relatives and Carers
* → Shared Decision-Making and Consent

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 45-year-old patient attends with long-standing back pain and says, “I am terrified this is cancer.” They are speaking rapidly, giving lots of detail, and appear close to tears. You are slightly behind schedule.

Options:
A. Say, “It is not cancer,” and move straight to examination to save time.
B. Interrupt and say, “We only have a few minutes, just answer my questions briefly.”
C. Ask an open question to invite their story and main worries.
D. Use body language that shows attention (e.g. face them, pause typing, maintain appropriate eye contact).
E. Reflect their emotion and fear in simple language.
F. Provide a long explanation about back pain without asking what they are worried about.
G. Summarise what you have heard, check you have understood correctly, then outline a focused plan and safety-net.
H. End the consultation once you have written a prescription, without summarising or checking understanding.

Example SJT — Rank 5 (best → worst)

You are 20 minutes behind in a morning clinic. A parent talks rapidly about their child’s cough and keeps adding details. They look anxious and say, “I am really worried something serious is being missed.”

Options:
A. Acknowledge the worry, use one open question to identify top concerns, summarise what you have heard, focus on key symptoms and red flags, agree a clear plan and safety-net, and document it.
B. Interrupt early and say, “I have only got a few minutes,” then issue a prescription for cough medicine.
C. Let them talk without interruption for the entire slot and end the consultation without a clear plan.
D. Reassure repeatedly that “it is nothing serious” without asking what they are worried about.
E. Avoid eye contact while typing and ask only closed questions to get through the checklist.